Diabetes: Is it time to flatten the curve?

Sarah Blake is an interdisciplinary PhD student at the University of Bristol. She is on Twitter: @sarahblake200

Adecade ago, out of the blue, I received a type 1 diabetes diagnosis.  Over the next few months, I focused on trying to reduce post-meal blood sugar spikes and episodes of hypoglycaemia. In the language of pandemics, I tried to ‘flatten the curve.’ Alongside my insulin regime, I began to reduce my starch and sugar intake. I was careful about when I ate high-glycaemic foods and tried to combine high-glycaemic food groups with unsaturated fats, proteins, or fibre to avoid peaks and troughs in my blood sugar. It worked. My blood sugars quickly fell to under 7 mmol/L.

I also started to notice that as a society, we do not pay much attention to blood sugar ‘spikes’ or post-prandial high blood sugars. Perhaps, because they are invisible or difficult to measure (unless we have a continuous blood monitoring device). Our language tends to focus on ‘weight’ or ‘calories’, both measurable variables. But ‘low-calorie’ foods do not always equate to a ‘low-glycaemic’ index. As a result, we may miss out on opportunities to adjust our diets and balance our blood sugar.¹

There are modest changes which could be made, such as diluting our child’s fruit juice, adding protein to an otherwise starchy and sugary breakfast, or snacking on nuts, cheese, or yoghurts. Small alterations to meals, such as changing the ratios on our Indian takeaway or roast, by reducing the potato, naan, rice, and Yorkshire puddings and increasing the proteins and high-fibre legumes or vegetables could help flatten the elevated peaks.

I began to work with pre-diabetic patients as a group facilitator. Surprisingly, many patients believed they were eating a healthy diet. There would often be people in each group who had an average or low BMI and wanted to maintain or gain weight, whilst reducing their blood sugars. Identifying the high-glycaemic foods in their diets, and finding the lower glycaemic alternatives, changing food group ratios, avoiding starchy and sugary foods in isolation or just before bed, could often make significant changes to their HbA1c.

Research from the National Diabetes Programme 2017/2018 indicates half of patients with elevated blood sugars, with an HbA1c greater than 42, are not clinically obese.² Approximately 15% have a BMI of less than 25, meaning the patient is average or under-weight. Many of these patients would have been unaware that they were at risk of diabetes. Risk factors often include weight, age, ethnicity, and blood pressure. High-glycaemic diets or blood sugar spikes are curiously absent from these lists, despite being linked as a cause of type 2 diabetes.³

Weight and calorie counting may be helpful to some patients. But for those who do not find it beneficial, patients with a BMI under 25, or for those who have struggled with dieting, perhaps opening up perspectives and language around blood sugar peaks and troughs and learning how to ‘flatten the curve’ may be useful.

References

1. Zafar MI, Mills KE, Zheng J, Regmi A, Hu SQ, Gou L, Chen LL (2019) Low-glycemic index diets as an intervention for diabetes: a systematic review and meta-analysis. Am J Clin Nutr. 2019 Oct 1;110(4):891-902. doi: 10.1093/ajcn/nqz149. PMID: 31374573
2. NHS digital (2019) ‘Diabetes Prevention Programme, 2017-2018 Diagnoses and demographics. Available from www.files.digital.nhs.uk
3. Livesey G, Taylor R, Livesey H, Liu S (2013) Is there a dose-response relation of dietary glycemic load to risk of type 2 diabetes? Meta-analysis of prospective cohort studies. Am J Clin Nutr. 2013;97:584-96

Featured photo by Casey Lee on Unsplash